Cervicale wervelkolom: theorie en klinisch
redeneren
Examen casus
- Body chart gegeven, en informatie
- Vragen over MDRCF: antwoord beargumenteren
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Vragen uit 5 artikels
Cursusteksten: theorie gekend (buiten extra reading)
Anatomie: geen oorsprong en aanhechting van spieren gevraagd, wel vragen over welke spier op rek komt
Intro CWK
Musculoskeletal disorders (MSDs) of cervical spine (Cx)
→ Refers to clinical conditions that involve nerves, tendons, muscles, joints and supporting structures of Cx
- Examples of MSD Cx
o Cervical hypomobility (or cervical articular dysfunction)
o Cervico-brachialgia (uitstraling van nek naar arm)
o Cervical radicular pain (schietende pijn van zenuwwortel naar arm)
o Cervical radiculopathy (verminderde geleiding → voosheid, tintelingen, doof gevoel,
krachtsverlies, afwezige reflexen)
o Postural syndrome (houding heeft invloed op klachten)
o Cx myofascial pain (trapezius syndrome)
o Cervicogenic headache
o Tension type headache
o Acute pain following Motor Vehicle Accident (MVA)
o Chronic pain following MVA (WAD)
o Cervical instability (bv door fractur of hypermobiliteit)
Cervical spine-related MSDs
- Can give rise to neck pain and/or radiating pain and/or associated symptoms
,Facts and figures
Blijft toenemen
Hoge kost
Common MSD
- NP (neck pain) reported to be 2nd most common reason leading to disability and injury claims
Economic burden of NP
- 2nd only to LBP in workers’ compensation claims in USA
→ Nekpijn & lage rugpijn = grote kost in maatschappij
Point prevalence NP
- 10% at any one time
- 13,8% of population aged > 18j
- Point prevalence: 5,9 – 22,2% for adult population (15-74j)
Year prevalence
- 45-54% each year
- More percentage in workers
- NP with associated disability: 1,7 – 11,5% in general population
Life prevalence
- 50-75% of individuals have neck or shoulder pain at least once in their life
Common in outpatient physiotherapy practice
- Cx-related MSDs account for approximately 25% of patients seen in outpatient physiotherapy
Gender differences
- Chronic NP is more common in women (22%) than in men (16%)
Temporal definition – based on timeline
- Hyperacute: first week
- Acute neck pain: 0-3 weeks’ duration of pain and/or disability
- Sub-acute neck pain: 4-12 weeks’ duration of pain and/or disability
- Chronic/persistent neck pain: more than 12 weeks’ duration of pain and/or disability
- Recurrent neck pain: patients seeking help after at least 1 month of not seeking care or being on
sick leave after at least 1 month of working
Persistent neck pain
- Rarely associated with
, o Serious tissue damage (abnormal anatomical structure)
o Identifiable underlying disease
- Classified as ‘non-specific’ neck pain (NS-NP)
Many and diverse treatment approaches for (NS)-NP
- Most patients receive conservative treatment from a general practitioner or a physiotherapist
- Traditional biomedical model: diagnosis aims to identify an anatomical structure or pathology
responsible for disorder
- Most patients with NS-NP: definitive pathology cannot be identified → this biomedical model fails
to direct treatment
- What are indicators to direct the intervention?
- What causes neck pain when there is no tissue damage?
Natural course of NP
- Remains unclear
- Normally self-limiting within a few weeks of onset
- Sometimes persistent
o Severely limiting daily functioning
o Resulting in prolonged sick leave and disability
o Inducing substantial medical consumption
- Places a heavy burden on individuals, employers and health care services
Acute pijn
- Veel pijn, weefselschade mogelijk
- Herstel: schade herstelt samen met reductie van pijn (normaal binnen 6 weken)
Persisterende pijn: tijdens herstelperiode toch nog pijn
Bergtop: acute pijn Heuvels: persisterende pijn
, Psychosociale factoren die lichaam gevoelig kunnen maken
- Stress, slaaptekort, bewegingsangst, aandacht voor pijn, drinken en roken, slechte voeding,
maladaptieve cognities, emoties
→ Centrale sensitisatie: pijnsysteem overactief
Persistent neck pain
Cx related MSDs & heterogeneity
Elke patiënt individueel bekijken
- Per patiënt oorzaak van klachten vinden (analogie met boomstam/ijsberg)
NS-NP is
MULTIDIMENSIONAL
